Payment Methods and Alternatives

Submitted by tomrue on

If you are not covered by any of the insurers listed at left...

Out-of-Network Authorization and Federal Parity Laws

If you have insurance with Out-of-Network coverage, a percentage of your fee may be reimbursed directly to you by your insurance company.

Under the Federal parity law, plans that provide Out-of-Network coverage under the medical/surgical benefit must provide on par Out-of-Network coverage under the addiction/mental health benefit. (Download a free PARITY TOOLKIT from mentalhealthparitywatch.org.)

I can provide you a monthly claim form to submit to your insurance company for reimbursement, or you may find one on their website. Please be sure to verify your particular plan's Out-of-Network benefits for outpatient mental health treatment. The initial request for Out-of-Network approval must come from you, the member, not the care provider.

You would be responsible for the $125 initial session fee and $100 subsequent session fees at the time services are provided. Out-of-Network reimbursements by your insurance company would then go to you.

You are responsible for your co-payment, if there is one, prior to each session. You will be responsible for the full fee for any missed or cancelled sessions. I cannot bill your insurance company for missed sessions. See below for more information about the cancellation policy.

Following are examples of insurance companies in which I do not presently participate. These companies have told me they believe they are not presently accepting any new licensed mental health counselors in this ares. I will be pleased to join their networks when they realize that the error of this policy, with the shortage of qualified providers in rural areas.

Due to privacy laws, it is up to you to find out the extent of your Out-of-Network benefits and obtain any necessary authorization. I will do my best to assist you in meeting their reporting requirements before and throughout treatment.

  • Empire Blue Cross/Blue Shield (use their Claim Form if you have out-of-network coverage).
  • Magellan Health (use their Claim Form if you have out-of-network coverage).
  • UnitedHealthcare/Oxford (see their Special Notice about out-of-network reimbursement).

    Should they require it, my NPI number is 1548588023. The site of treatment services is 433 Broadway, Monticello, NY 12701. I am a Licensed Mental Health Counselor (Lic. #000461) and a Credentialed Alcoholism & Substance Abuse Counselor (#10741) in New York State and a Certified Clinical Mental Health Counselor (#22579) with the National Board for Certified Counselors. They are welcome to contact me directly to discuss a Single Case Agreement if they wish.

    Related Articles

    How To Get Care From Out-Of-Network Providers (CDPHP)

    Getting Or Keeping An Out Of Network Doctor (Mass Legal Help)

    Understanding Your Mental Health Insurance (AACAP)

    New Empanelments

    With perhaps a rare exception, when asking your insurance company if they will approve you seeing me out-of-network, you may assure them that if they will work with me toward empanelment, I will accept their usual and customary in-network fee (together with your usual co-pay) as payment in full. I am willing to join new networks to join, but it is a lengthy process so you will still need out-of-network approval.

    Some companies may be unaware of the level of education and experience that New York State requires for Licensed Mental Health Counselors, and are invited to review a COMPARISON OF LICENSURE REQUIREMENTS FOR LMHC, LMSW, and LCSW or contact the AMHCA or NBCC for more information.

    If you are uninsured...

    If you have no health insurance, or if you have a policy that does not cover mental health or substance abuse counseling, feel free discuss with me your treatment needs and what you can afford. If we can not come to an arrangement, I will attempt to refer you to a provider that can meet your needs.

    Personal checks are accepted, payable to CHOICES MENTAL HEALTH COUNSELING, PLLC, either in person or mailed to PO Box 706, Monticello, NY 12701. Returned checks are subject to a $25 administrative fee, in addition to the value of the returned check and reimbursement of any associated bank fees.

    These additional payment methods are offered for your convenience:

    Non-covered services...

    Some services, such as report preparation, court testimony, a pre-adoption home study for example, may not be covered by insurance and are billed by the hour and the regular hourly fee. Check with your human resource department or insurance provider if unsure whether a service is covered or not.

    If you are in jail or just got out (possibly even if you were only detained briefly), you may find that your Medicaid has been canceled. If unsure, call the number on the back of your card or have someone do so for you. You may need to reapply at your local DSS.

    For home visits, jail interviews, court appearances, or other services outside of the office, time and travel expenses will be charged.

    Cancellation policy...

    When a regular appointment time is set for you, that hour is reserved for your exclusive use, and you will therefore be charged in full for any missed or cancelled sessions. We will not charge for up to three missed sessions per year if at least 24-hours notice is given. This includes time off for vacation, illness, or an emergency.

    Medications...

    Discuss with your physician the possible availability of "sample" packs of medically necessary prescribed medications, or helping you apply to any of these eligibility based resources:

    Support to Quit Smoking

    Pharmaceutically Funded

    Retail Generics

    The Sullivan County Legislature offers 10% discount cards for medications, reportedly accepted by most local pharmacies. Get one at the Choices office, from your your Legislator, or at the Legislative Chambers on the second floor of the County Government Center at 100 North Street, Monticello, NY 12701.

    Compare Costs

    The NYS Department of Health collects retail price information on these drugs from pharmacies that accept Medicaid from pharmacies that submit their retail price information directly. Search by ZIP Code and by medication name to comparre pharmacy prices in New York State.

    Applying for government benefits...

    Try the following online tools to check out if you are financially eligible for Medicaid, Transportation, Temporary Assistance, Food Stamps, Medicare, Social Security, or other benefits. If you apply for managed care Medicaid, keep in mind that I do participate with Fidelis Care NY and Hudson Health Plan. I do not accept fee-for-service Medicaid or Medicare at present.

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